A Case of Pneumocystis carinii Pneumonia in a Patient with Relapsed Acute Myelogenous Leukemia / 감염

We experienced a 61-year old man with Pneumocystis carinii pneumonia who had been diagnosed as having relapsed acute myelogenous leukemia(AML). He developed severe dyspnea in the nadir state after reinduction chemotherapy. His chest X-ray showed bilateral interstitial pneumonia in both lung fields. We started ventilator therapy and obtained sputum through the endotracheal tube. Typical P. carinii cysts were found in the sputum by Giemsa stain. No other organisms were found in thelavage sediments. From clinical observation and the presence of typical P. carinii cysts, the patient was diagnosed as having P. carinii pneumonia and was treated with sulfamethoxazole/trimethoprim and glucocorticoid. This was the first reported case of P. carinii pneumonia in an AML patient undergoing chemotherapy in Korea.

Factors Influencing the Pathogenicity of Entamoeba Histolytica

In summarizing the results of the experimental studies up to the present, it is conjectured that the pathogenicity of Entamoeba histolytica or establishment of amoebiasis is not unique but differs by strain and age of Entamoeba histolytica and the age of the host. A non-virulent strain is more likely adapt to as low a temperature as 32 . This is not so in the strains which originated form clinical cases. Iso-enzyme patterns may roughly characterize pathogenic strains from non-pathogenic, Red blood cells may contribute as nutrients for growth of Entamoeba histolytica only after they have been hemolysed, but they are toxic to the amoebae as long as they remains intact. A low protein diet and stress may facilitate the establishment of amoebiasis; male sex hormones or previous infection by enteric bacteria provide a more advantageous condition than the female; and hepatotoxic agents will accelerate amoebic hepatitis.

Epidemiological survey on Metagonimus yokogawai infection in the eastern coast area of Kangwon-province, Korea

An epidemiological survey on Metagonimus yokogawai infection was performed in the eastern coast area of Kangwon province. Formalin-ether concentration technique and Stoll's dilution egg counting method were employed to figure out the prevalence and intensity of M. yokogawai infection and eating habits of inhabitants with raw freshwater fish. The results are summarized as follows: The prevalence rate of M. yokogawai infection was 6.6% among a total of 2,357 examinees; 8.6% (115 out of 1,345) in male and 4.0% (40 out of 1,012) in female. The prevalence rates were different by the streams where the examinees were residing: 17.8% along the area of Ohsip-cheon (stream), 11.8% along Maeup-cheon, 1.7% along Hwasang-cheon, 1.3% along Yeongok-cheon, 0.9% along Namdae-cheon, 0.9% along Sa-cheon and 0% in the other streams (Yongchon-cheon, Kangnung Namdae-cheon and Jusoo-cheon) in decreasing order. By social strata, the positive rate was 8.0% (122 out of 1,521) in general inhabitants and 3.9% (33 out of 836) in school children. By the intensity of infection by means of EPG counts in feces; the light infection (less than 400/EPG) was 74.1%, moderate infection (401-1,000/EPG) 17.3% and heavy infection (more than 1,001/EPG) 8.6%. Twelves out of 50 sweetfish (Plecoglossus altivelis) (24%) caught from the streams in eastern coast of Kangwon-Do were infected with metacercariae of M. yokogawai, and the number of larvae detected were 70.7 per fish in average. The metacercarial infection rate in fish were also different by the streams; 100% in Ohsip-cheon of Samcheok-Gun, 14.3% in Sa-cheon, 16.7% in Yeongok-cheon of Myeongju-Gun and 0% in Namdae-cheon of Yangyang-Gun, respectively. Six hundred ninety five (695) out of 1,396 inhabitants and school children (49.8%) were experienced in eating raw freshwater fishes (Plecoglossus altivelis, Tribolodon hakonensis, Coreoperca sp., Moroco sp., Carassius sp. & Cyprinus sp. and Zacco platypus). The data were assayed with the questionnaire collected from the examinees. In summarizing the above results, it is known that the Ohsip-cheon area of Samcheok-Gun is highly infected region, and the other areas of Kangnung Namdae-cheon, Yeongok-cheon and Yangyang Namdae-cheon are very lowly infected or non-infected regions for M. yokogawai infection.

A case of calabar swelling suspected as loiasis

This report deals with an imported case of calabar swelling suspective of loiasis, who had been in Nigeria, Africa for 2 years. This 33-year-old Korean technician was admitted to Severance Hospital, Yonsei University Medical Center, because of erythematous swellings on left hand and foot. His peripheral blood showed persistent eosinophilia (over 30 percent of WBC), increased IgE(1,000 unit/ml) and significantly high antifilarial antibody titer with enzyme immunoassay, although no microfilaria was detected on the peripheral blood films. Under the impression of Loa loa infection diethylcarbamazine was administered for a month. Four months later mobile swellings and eosinophilia disappeared, and anti-filarial antibody titers were normalized. It is assumed that the patient had suffered from Loa loa infection, which is the first report on loiasis in Korea.

Study on sensory papillae of Metagonimus yokogawai cercaria

A number of studies on the papillae of cercariae of trematodes reported that the papillar patterns (or chaetotaxy) of cercariae might be an excellent method to attain better understanding of the digenetic trematodes (Richard, 1971; Short and Cartrett, 1973; Bayssade-Dufour, 1979). The present study was aimed to determine the number, distribution pattern and structure of the sensory papillae of Metagonimus yokogawai cercariae, and to elucidate the chaetotaxy of this digenetic trematode. M. yokogawai cercariae were pipetted from a vial in which infected snails (Semisulcospira libertica) had been kept for 3 hours. The snails were collected from an endemic area of M. yokogawai, Boseong river in west-southern part of Korea. Observations of papillae were based on light microscopy of those stained with silver nitrate, and on scanning electron microscopy. The results are summarized as follows: All papillae observed were uniciliated. Cilia in anterior tip were shorter than the others in other portions. The body papillae were arranged in essentially symmetrical patterns. Total number of the papillae was 126(63 pairs) in average; anterior tip 40(20 pairs), ventral 20(10 pairs), lateral 42(21 pairs), and caudal 8(4 pairs). The chaetotaxy of M. yokogawai cercaria was; C(I) cycle (3+3C(I)V, 2+2C(I)L, 2+3C(I)D), C(II) cycle(2C(II)V, 1C(II)L, 2C(II)D), C(III) cycle (1+lC(III)V, 1C(III)L), C(IV) cycle (1C(IV)V, 1C(IV)L) in cephalic region: A(I)(lA(I)V, l+2A(I)L, 1A(I)D), A(II)(1A(II)V, 1+3A(II)L, lA(II)D), A(III) {lA(III)V, l+lA(III)L, lA(III)D) and A(IV)(lA(IV)V, 2A(IV)L) in antacetabular region: 1M(I)V and 2M(I)L in median: 1+lP(I)L, 1P(II)L, lP(II)D lP(III)L, lP(IV)L and 1P(IV)D in postacetabular region: 2-2-2-2 in caudal region.

A case of congenital malaria

A case of congenital malaria infection has been studied in a 46-day old female Korean infant. Her mother suffered from malaria infection during pregnancy in Uppervolta, Africa, and returned to Korea at the 9th month of gestation for delivery. At 39 days of age, the clinical features characterized by fever, irritability, pallor, jaundice and hepatosplenomegaly were developed. The laboratory data revealed a hemolytic anemia with thrombocytopenia, hyperbilirubinemia and increased hepatic enzyme values. A peripheral blood smear demonstrated intraerythrocytic malarial parasites snd gametocytes of Plasmodium falcifarum. She was successfully treated with quinine sulfate (25 mg/kg/day in three doses for 5 days) and trimethoprim/sulfamethoxazole (8 mg/kg/day in two doses for 5 days) orally, and repeated blood smear had been negative for malaria. This report also signifies the frst description of congenital malaria in Korea imported from Uppervolta in Africa. A brief review of related literature was made.

Ultrastructural observation of Naegleria fowleri trophozoite in mouse brain and axenic culture

Present study was undertaken to elucidate the changes of the ultrastructure of Naegleria fowleri trophozoite in brain tissue of mice and culture medium. Naegleria fowleri, 0359 strain, which used in this study was cultured in axenic liquid medium, CGVS medium. Each mouse was inoculated with 1 x 10(5) amoebas intranasally under secobarbital anesthesia, and sacrificed on 7th day after the infection. Comparative observation of the ultrastructure of the amoebas in axenic culture and experimentally infected mice brain was done with transmission electron microscope. The results are summarized as follows: The amoebas in mouse brain tissue were round in outline, whereas those of amoebas from axenic culture showed irregular appearance. Mitochondria in the amoebas from axenic culture was oval, round and cylindrical shape and darkly stained, whereas those of the amoebas from mouse brain tissue showed dumbbell shape together with above forms. The stain was not unique, but light and/or dark. Rough endoplasmic reticulum of amoebas in brain tissue was tubular, but from culture it was vesicular or tubular in shape. Empty vacuoles were demonstrated in amoebas from culture, while food vacuoles with myelinated structures were abundant in those from tissue, suggesting a strong phagocytic activity. Mouse brain tissue infected were extensively destroyed, and polymorphonuclear leukocytes were infiltrated predominantly with inflammatory lesion. Amoebas were observed in the vicinity of the capillary.

Epidemiological studies on Clonorchis sinensis infection along the Nam-river in Gyeongnam province, Korea

The prevalence of C. sinensis infection along the Nam river, Korea, was 38.7% of 5,291 people examined. Prevalence rates varied from 42% at the upper stream to 34% at the middle stream and 40% at the down stream region. Rates were highest (53.4-54.3%) in the 30-59 years of age group. The positive rates in primary school chidren, school students, teachers and local officers, and other inhabitants were 16.5%, 22.6%, 46.2% and 49.6% respectively. 53.6% of cases were light infected, i.e. less than 4,000/EPG. The cercarial expulsion rate of 5,005 Parafossarulus sp. was 0.34%. Snails naturally infected with C. sinensis expelled about 788 cercariae/day. Ten of 18 species of freshwater fish examined had C. sinensis metacercariae. To prevent clonorchiasis in the endemic areas, the effective health education system is suggested as a control measure. [retyped from English summary]

Evaluation of specific IgE antibody in Clonorchis sinensis infection

Serum IgE level and Clonorchis specific IgE in individuals with Clonorchis sinensis were determined by radioimmunosorbent(RIST) and radioallergosorbent technique(RAST) respectively. Highly significant elevations of serum IgE (P<0.001) and specific IgE antibodies (P<0.01) were observed in area from individuals with clonorchiasis. The mean values of serum IgE in individuals with clonorchiasis and healthy individuals were 2,372 IU/ml and 364 IU/ml respectively and specific IgE antibodies of both groups were 52.0 and 4.4%. A close correlation(r=0.9451) between serum IgE level and specific IgE antibodies were observed and correlation (r=0.6056) between serum IgE and EPG and between specific IgE and EPG(r=0.5693) were also observed.

Parasitic amebae in Korea

This review dealt with biology, host-parasite relationship, symptomatology, epidemiology, diagnosis, treatment of Entamoeba histolytica infection and free livng amoeba.

Congenital Toxoplasmosis

No abstract available.

Epidemiological study on Metagonimus yokogawai infection along Boseong River in Jeonra Nam Do, Korea

Prevalence study of Metagonimus yokogawai infection, survey of intermediate hosts of Metagonimus yokogawai and food habits of raw sweetfish among inhabitants along Boseong river (120 km), Jeonra Nam Do (province) were carried out. The results are summarized as follows: Among 360 examined, the egg positive case were 128(35.6 percent); male 112(46.7 percent), female 16(13.3 percent). The prevalence rates were different by geographical areas; 42.4 percent in down stream, 49.4 percent in middle stream and 13.3 percent in upper stream. By ages, highest rate, 53.6-59.1 percent was observed among 30-49 group (male 69.6-73.0 percent, female 15.8-35.5 percent). Eggs per gram of feces were 2,084 (200-12,280) in average; down stream 1,708, middle stream 2,590, upper stream l,550. By social strata, the prevalence showed differences; 24.8 percent in primary schoolchildren, 78.4 percent in school teacher and local officers, 30.6 percent in general inhabitants. Clonorchis sinensis infected cases in the areas were 21(5.8 percent) out of 360 examined, and 90.5 percent of them showed mixed infection with Metagonimus yokogawai. Cercariae of Metagonimus yokogawai from the lst intermediate host, Semisulcospira sp., in down and middle streams were detected from 32 snails (5.9 percent) out of 545 examined. All the 22 Plecoglossus altivelis which were caught from the down stream were infected with metacercariae of Metagonimus yokogawai. The number of the metacercariae detected was 22,650 per fish in average, and the number increased from August to October. Experiences of raw sweetfish intake of the inhabitants were found in 208(58.4%) among 356 interviewed by questionaire form (male 76.7 percent, female 20.7 percent). Means of acquisition of the sweetfish were mostly by purchase 68.8 percent, and seasonally in summer. Reason of the raw sweetfish intake was due to the flavor, 83.2 percent. The fish were mixed in soy sause with vinegar before the intake.

Niclosamide in the treatment of tetagonimiasis

Anthelmintic effect of niclosamide [N-(2-chloro-4-nitrophenyl)-5-chloro-salicylamide)] on Metagonimus infection was carried out to the cases in area of Seomjin-river. The drug, one tablet contains 0.5 g of niclosamide was supplied from Bu-gwang pharmaceutical company in Seoul. Sixty five cases were divided into three groups by the regimen: Group l given 2 g(4 tablets) for one day, Group II for two successive days and Group III for three successive days. Stool examination was done before and 2-3 weeks after the drug administration by formalin-ether concentration and Stoll's dilution egg counting techniques. The results were as follows: Egg negative conversion (cured) and egg reduction (more than 80 percent decrease) rates were 28.6 percent, 10.7 percent in group I, and 31.8 percent, 27.3 percent in group II. But of those in group III treated for three successive days, 73.3 percent was cured and 26.7 percent showed egg reduction, and the general egg reduction rate was 95.1 percent. The results in the present trial suggested that the niclosamide has anthelmintic efficacy when it is used in 2 g for more than three successive days.

Immunological tests by anti-free-living amoebas serum produced in experimental animals II. Indirect fluorescent antibody titer of anti-free-living amoebas serum produced in rabbits

The indirect fluorescent antibody test was performed to demonstrate the antibody production in the rabbits immunized with free-living amoebas; Acanthamoeba culbertsoni and Naegleria fowleri, and antibody titer changes by immunization duration. Rabbits were immunized with Acanthamoeba culbertsoni and Naegleria fowleri which were cultured axenically in CGVS medium. For experiments, rabbits were divided into two groups; small dose group received 10(4) intravenously with live or dead free-living amoebas trophozoites as an immunizing dose three times with one week interval, and large dose group received 10(6) live or dead trophozoites respectively. The control group received physiologic saline or medium for culture of free-living amoebas intravenously. Antiserum was collected 4 times at interval of 3 days in the first 10 days, and also up to 2 months later. In the group immunized with live Acanthamoeba culbertsoni, fluorescent antibody titer was higher than in the group of dead one, and also in the large dose group than in the small dose group. Antibody titer of anti-Naegleria fowleri serum in the large dose group showed no difference by the source of amoeba antigen; live or dead. But in the small dose group, antibody titer was higher in the immunized with live Naegleria fowleri than in the group with dead one. No cross reactivity was demonstrated between the Acanthamoeba and Naegleria. And no cross reaction was observed when the free-living amoebas antigens were tested against human sera of amoebiasis, paragonimiasis and clonorchiasis.

Fates of degranulated mast cells and extruded granules responded to homologous antigen in rats infected with Clonorchis sinensis

: Fates of degranulated mast cells by challenge of the homologous antigen to the Clonorchis sinensis infected rats, and the extruded granules were examined by means of light and electron microscopy. The whole experiment was carried out six weeks after the Clonorchis infection and an observation was made at 1, 3, 5, 8, 12 hours after the antigen challenges. The abdomen of the infected rat was cut open by 2 centimeters and the antigen was directly inoculated to mesentery, then again sutured. According to the scheduled period, the rat was sacrificed. The challenged portion was cut out and followed by dying procedure. The results of the observation are summarized as follows: Degranulation was observed within one hour without noticeable change of the granules. Three hours after the inoculation, the shed granules were phagocytized by macrophage surrounding the mast cells. They were aggregated in the cytoplasm. In 5 days phagocytosis phenomenon were almost completed but still some granules were scattered in surroundings upto 12 hours. The nucleus of the degranulated cell appeared clearly in contrast to normal cells which were killed with granules. Membrane became to normal, and the granules which were not expelled out agglomerated in a large cavity. The above resulst suggest that the partially degranulated mast cells do not disintegrate, but recover to normal, and expelled granules are phagocytized by macrophages.

Behaviour of mast cells in mice in the course of Entamoeba histolytica infection by strains

The present report deals with the behaviour of mast cells in mice in the course of Entamoeba histolytica infection by the strains. Mice weighing about l6 gm were used for three experimental groups; control, sham infection and experimental. The experimental group was infected with Entamoeba histolytica trophozoites directly into cecum by laparotomy. Strains isolated from three hepatic amoebic abscess cases were used. Mesenteric samples from the region of terminal ileum were fixed in methyl alcohol and stained with Pugh's solution. The ulcers in cecum were examined. Changes in number and structure of mesenteric mast cells and blood eosinophils were as follows. The number of mast cell in mesenteric tissues of the infected group increased from first day of the infection and persisted up to 34th day of the observation period. Degranulation and disruption of mast cells increased in the infected group compared with groups of the sham operation and the contro1, but showed no difference by the strains of Entamoeba histolytica. The blood eosinophilia was observed in the infected group and persisted until the observation period. Ulcers in cecum were found in all the infected groups. The results above indicate that mast cells are keenly related with the course of Entamoeba histolytica infection.

Flea fauna of rodents in coastal region of Korea :Insecticide susceptibility test of Xenopsylla cheopis

A survey on rats and rat-fleas was performed in costal area of Korea during 1972 in Inchon, Kunsan, Yosu, Busan and other areas. The number of the caught rats was 1,448. Total number of collected fleas was 2,480. Geographical distribution were described. Flea index was in 1.71 total. Mothly flea indices were 0.35-0.84 in January to March, 2.13-2.59 in April to June, 0.58 in July and 1.82-4.91 in August to November. Mortality rate of X. cheopsis to various concentration of DDT in 1 hour exposure were 43.8 % in 4.0 %, 30.4 % in 1.0 %. In 24 hours exposure, the mortalities were 100 % in 4.0 %, 91.5 % in 2.0 %, 73.5 % in 1.0 % and 37.0 % in 0.5 % DDT.

Prevalence of intestinal parasites in Korea

A survey of intestinal parasites infection among Korean people has been carried out during July 1969 to December 1970. A total of 2,250 stool specimens (male 1,101, female 1,146) was collected from all the provinces and Seoul city in Korea. The specimens were examined routinely by direct fecal smear, zinc sulfate flotation and formalin-ether sedimentation techniques. The results are summarized as follows: Of 2,250 specimens examined, l,803(80.l per cent) were positive for intestinal parasites. The positive rates of intestinal helminths were 1,644(73.1 per cent) among 2,250; Ascaris lumbricoides 46.0 per cent, Trichocephalus trichiurus 46.8 percent, hookworm 6.8 per cent, Trichostrongylus orientalis 7.0 percent, Clonorchis sinensis 12.1 percent, Enterobius vermicularis 1.6 per cent, Hymenolepis nana 0.7 percent, Taenia species 0.3 per cent, Metagonimus yokogawai 0.04 percent, Fasciolidae 0.04 per cent and one case of lung fluke Paragonimu westermani. The positive rstes of intestinal protozoa were 786(34.9 per cent); Entamoeba histolytica 6.4 per cent, Entamoeba coli 20.5 percent, Endolimax nana 10.0 per cent, Giardia lamblia 5.1 per cent, Trichomonas hominis 1.1 percent, Chilomastix mesnili 0.5 percent, Iodamoeba butschlii 0.6 percent, Enteromonas hominis 0.7 percent, Dientamoeba fragilis 0.1 per cent and one case of Isospora hominis. Sexual distribution of helminths and protozoan infections showed higher rate in female than that of male, except C. sinensis, H. nana, Taenia species or G. lamblia Infections of T. trichiurus, hookworm, T. orientalis, C. sinensis, Taenia species, E. histolytica, E. coli and E. nana increased with age. Conversely, H. nana and G. lamblia infections were more predominent in younger ages.

Anthelminthic effectiveness of 2,3,5,6,-tetrahydro 6-phenyl-imidazole (2,1-b) thiazole hydrochloride (=tetramisole) upon intestinal parasites

A single dose of Tetramisole, 2.5 mg/kg body weight, was given to the infected cases of intestinal parasites. The number of cases were: Ascaris lumbriocides 96, hookworm 16, Trichostrongylus orientalis 10, Trichocephalus trichiurus 114 and Clonorchis sinensis 19. No dietary restriction before and after the administration of Tetramisole was required. In Ascaris infection the egg negative conversion rate and the egg reduction rate were 92.7 per cent and 99.5 per cent, respectively. In Trichostrongylus orientalis infections, 9 out of 10 cases were resulted egg negative after the single dose of Tetramisole, and hookworm, 12 out of 16 administered showed egg negative. However, there were no appreciable effectiveness to the cases of Trichocephalus trichiurus and Clonorchis sinensis. Mild and transient side effects were noted in 75 cases (54.5%) out of 140 cases. The main symptoms were dizziness (25.5%), anorexia (25.5%), abdominal pain (18.6%), diarrhea (16.6%), headache (15.2%), nausea (14.4%) and fever (11.0%). From the above results, it is anticipated that Tetramisole is an effective anthelminthic for elimination of Ascaris, Trichostrongylus and hookworm.

Metronidazole in amoebiasis 1. The use of metronidazole on the treatment of hepatic and pulmonary amoebiasis

Total 9 cases of extraintestinal amoebiasis, amebic liver abscess and amebic lung abscess, were treated with metronidazole. The diagnosis and progress check were done by (1) stool examination, (2) size and pain of liver, (3) hematological examination, (4) urinanalysis, (5) X-ray or liver scanning (6) examination of aspirated pus from liver and (7) immobilization test of E. histolytica. Results are summarized as follows: Amebic hepatitis: Metronidazole was given to 3 cases with daily dose of 0.9-1.2 gm for 3-7 days. Clinical symptoms were completely restored by the treatment. Amebic lung abscess: One case was treated with metronidazole for 3 days with the daily dose 1.2 gm. X-ray findings showed remarkable improvement by the treatment. An additional administration of the drug for 6 days resulted complete resolution of the pneumonic changes. Amebic liver abscess: Four cases were treated with metronidazole. The daily doses were 0.4-2.4 gm and continued for 2-10 days. Aspiration of the abscess for 1-10 times or continuous drainage of pus were performed during the course supplementarily. All cases were recovered to normal by the combining treatment. No remarkable side effect was noticed by the drug administration, and no relapse was experienced up to date.